• Saraswathi Nagappa, Raghavendra Biligiri Sridhara, and Sandhya Kalappa.
• Department of Anesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
• Anesth Essays Res. 2019 Apr 1; 13 (2): 204-208.

BackgroundThe biggest anesthetic challenge in infants with thoracolumbar /sacral meningomyelocele is securing the airway. For securing the airway, most of the anesthesiologist's practices supine position with doughnut or head ring placed around the swelling to prevent rupture, which has got disadvantages like risk of rupture, infection and damage to neural structure. Left lateral position has been recommended previously for tracheal intubation in post-tonsillectomy hemorrhage. Several studies have shown successful ventilation in lateral position using laryngeal mask airway and intubation using video laryngoscopes.Aims And ObjectivesPrimary objective is to compare the time taken for intubation, number of attempts required for intubation. Secondary objective is to compare ease of mask ventilation, Cormack Lehane grading and Backwards Upward Rightwards Pressure [BURP] manoeuvre.Materials And MethodsA comparative, prospective randomized, controlled trial of 60 infants undergoing thoracolumbar/sacral meningomylocele repair. Infants were allocated to one of two groups of 30 patients each, by computer-generated randomization into Group S: mask ventilation, laryngoscopy and intubation in supine position and Group L: mask ventilation, laryngoscopy and intubation in lateral position.Statistical MethodsChi-square/Fisher Exact test was used to find the significance of study parameters on categorical scale between two or more groups.ResultsMean intubation time of sixteen seconds were clinically acceptable and comparable in each of the two positions P = 0.145. Ten patients in the left lateral position, eight patients in the supine position required second intubation attempts before the airway was secured. Only 8.3% of our patients required third intubation attempts.ConclusionAnesthesiologist should pay more attention to the safety and quality of mask ventilation, laryngoscopy and intubation in meningomylocele infants. Both supine and lateral position were comparable.

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